Biomedical subjects

Elspeth Cameron Ritchie

Publications and source records attributed to Elspeth Cameron Ritchie.

14 recordsLinked to original sources

PubMed2006

Psychiatry and the military: an update.

The United States has historically been concerned about the successful adjustment of its military members returning from war. These concerns are based on the recognition that war-zone exposures may have considerable negative emotional or behavior consequences. As the global war on terror continues, the United States military medical system will be required to address issues at the interface of psychiatry and the law. Despite clinical advances within the theater of war and at tertiary facilities in the United States, some military members will develop chronic and disabling mental illness as a result of traumatic exposure and exacerbated by the demands of the austere and dangerous operational environment. The extent to which violent and aggressive behavior in the aftermath of deployment can be attributed to combat experience remains an area of debate and ongoing investigation. However, experience suggests that a very small subgroup of the hundreds of thousands of war veterans deployed in conjunction with the current conflict in Iraq has already been involved in violent crimes. For this group, military forensic psychiatrists will be called on to make determinations of competency and criminal responsibility and to inform the courts about the potential contributions of war-related distress or disorder to criminal behavior. Though the overwhelming majority of war veterans will not be involved in criminal proceedings, a minority will develop career-ending (and in rare instances, life-ending) disabilities as a result of mental illness. For those who are no longer fit for duty, the military Physical Disability Evaluation System must make determinations of the extent to which future military performance and future civilian social and occupational function have been compromised. For a small yet highly visible minority of returning veterans, questions about the cause, precipitants, and manner of death will necessitate psychological autopsies. This article highlighted recent updates in military forensic psychiatry and the mechanisms through which answers to questions of disability and criminal culpability, and motivation underpinning self-injurious behavior, are determined within the United States military. As the global war on terror progresses, further experience and study of our country's judicial processes, disability system, and the policies and procedures governing psychological autopsies must evolve to meet these increasing demands.

Brain Concussion↗

PubMed2004

Military issues.

This article reviews of some of the lessons in trauma psychiatry learned by the US military through wartime and other trauma experiences during the past century. Current practice in the military's employment of stress control teams is reviewed. The military's efforts to prevent and limit psychological casualties, to include the care of battle casualties and prisoners of war (POWs), are addressed. Recent experiences that have informed further, and are shaping the military's approach to managing the psychological aftermath of trauma (such as the Sept. 11, 2001, attack on the Pentagon and the current war with Iraq) are included. Guidelines developed after 9/11, and articulated in the "Mass Violence and Early Intervention" conference are presented. Finally, current ideas on preparation for and intervention after weapons of mass destruction will be outlined.

Humans↗

PubMed2004

Mass violence and early mental health intervention: a proposed application of best practice guidelines to chemical, biological, and radiological attacks.

Based on past episodes, there will be psychological sequelae to chemical, biological, and radiological attacks. Some of the psychological morbidity should be able to be ameliorated through planning and appropriate early intervention. Key components of early intervention are illustrated following a hypothetical scenario of a bomb and anthrax threat near the Pentagon. Many of these components, such as monitoring clear, consistent messages about health risks, are provided by physicians or politicians, not mental health providers, but have a serious impact on the mental health of the population. We hope that this scenario and the principles of response will prove useful to planners of emergency preparedness and responders in the case of an actual attack.

Bioterrorism↗

PubMed2003

The contributions of Kenneth Leslie Artiss, M.D.

Kenneth Leslie Artiss (1913-2001) was an Army psychiatrist who did significant investigative work in schizophrenia and milieu therapy and whose broad scholarship led to decisively important and enduring contributions to operational psychiatry. After retirement from military service, he developed a bold approach for teaching psychodynamic theory and its applications, and he led seminars for psychiatry residents and other physicians for over four decades. He was among the first to apply psychodynamic ideas to improve oncology practice. His death in 2001 motivated a group of his military students to memorialize his life and contributions and to demonstrate why they merit continuing consideration.

Group Processes↗

PubMed2003

Suicidal admissions in the United States military.

Suicide is currently the second leading cause of death in the U.S. military. Little recent research has been done on a well-defined cohort at high risk for death by suicide, which consist of military patients who attempt suicide or are admitted for suicidal ideation. As a pilot investigation based on a literature review of suicidal behavior in the U.S. military, 100 consecutive charts of suicidal patients at a tertiary military treatment facility were reviewed. The findings included the following: 94% were admitted with a depressed mood; 67% had a history of previous attempts or gestures; 49% had been treated with psychiatric medication prior to admission and 88% were treated with psychiatric medications while on the ward; 47% returned to a full duty status; 29% were recommended for administrative separation; and 18% were recommended for a medical board. Suggestions for future research are presented to help improve our suicide prevention programs.

Adult↗

PubMed2003

Chemical warfare and the Gulf War: a review of the impact on Gulf veterans' health.

It is unlikely that Gulf War veterans are suffering chronic effects from illnesses caused by chemical warfare nerve agent exposure. Extensive investigation and review by several expert panels have determined that no evidence exists that chemical warfare nerve agents were used during the Gulf War. At no time before, during, or after the war was there confirmation of symptoms among anyone, military or civilian, caused by chemical warfare nerve agent exposure. However, studies of Gulf War veterans have found belief that chemical weapons were used, significantly associated with both severe and mild-moderate illnesses. The psychological impact of a chemical warfare attack, either actual or perceived, can result in immediate and long-term health consequences. The deployment or war-related health impact from life-threatening experiences of the Gulf War, including the perceived exposure to chemical warfare agents, should be considered as an important cause of morbidity among Gulf War veterans.

Chemical Warfare↗

PubMed2003

Breastfeeding in the military: Part I. Information and resources provided to service women.

Increasing the incidence and duration of breastfeeding is a major goal in Healthy People 2010. Little is known about the progress that the Department of Defense (DoD) health care system, TRICARE, has made toward reaching that goal. This study is the first of a two-part series that reviews DoD/TRICARE support for breastfeeding and discusses policy issues related to breastfeeding. Methods used include searches of MEDLINE, DoD/TRICARE documents, legislative and policy websites, and the Internet. A survey of DoD hospitals was also conducted. Based on the search results and survey, TRICARE may not be meeting the goals of Healthy People 2010. There is minimal policy guidance regarding breastfeeding. Programs are in place at most hospitals, but the quality and content varies greatly. After mothers return to work, support is meager. DOD/TRICARE may need to establish written policy guidelines and devote additional resources to adequately support breastfeeding.

Breast Feeding↗

PubMed2003

Breastfeeding in the military: Part II. Resource and policy considerations.

Breastfeeding is widely acknowledged as the ideal form of nutrition for infants. Because of this, increasing the incidence and duration of breastfeeding is a major goal in Healthy People 2010. Part I of this series illustrated that the Department of Defense and its health care system, TRICARE, may not be meeting that goal, particularly after active duty mothers return to work. This study outlines the resources that would be required to optimally support breastfeeding after active duty mothers return to work. Selected policy implications of supporting breastfeeding are discussed, and recommendations for policy on breastfeeding are presented.

Breast Feeding↗

PubMed2002

Caring for civilians during peace keeping missions: priorities and decisions.

Humanitarian assistance is increasingly being offered by the military in operations other than war. Balancing issues of resources, priorities, and security is important but complicated. Sometimes errors are made that are costly, either in terms of public relations, morale, or lives. Unfortunately, not enough education of physicians and other medical personnel is done prior to the mission, as to how to weigh these aspects. No absolute guidelines can be recommended, as each situation is different, but some examples and guidelines are presented.

Developing Countries↗

PubMed2002

Perspectives on coordination from the Office of the Assistant Secretary of Defense/Health Affairs.

Many teams from each of the different military services, as well as numerous civilian agencies, were involved in providing care to the victims, survivors, and family members of the September 11th attacks. However, the different teams initially had difficulties with communication and command and control issues. This article describes the perspective from Health Affairs on coordination of those efforts.

Aircraft↗

PubMed2002

Operation Solace: overview of the mental health intervention following the September 11, 2001 Pentagon attack.

At the direction of the Army Surgeon General, the Army behavioral health consultants in psychiatry, psychology, and social work assembled in Washington, DC immediately after the September 11, 2001 attack to plan and implement a proactive behavioral health response to the Pentagon attack. The goal was to minimize the short- and long-term adverse behavioral health and related medical effects predicted to emerge based on past U.S. mass casualty scenarios. This article summarizes the goals, methods, and rationale used to develop the plan, as well as the key elements of the behavioral health intervention developed in response to the attack.

Aircraft↗

PubMed2002

Principles guiding implementation of the Operation Solace plan: "Pieces of PIES," therapy by walking around, and care management.

Operation Solace is the name given to a post-September 11, 2002 plan directed by the Army Surgeon General to proactively address the predictable behavioral health distress/disorders and related somatic phenomenon expected to occur among the Pentagon employees, family members, and Department of Defense beneficiaries located in the National Capitol Region affected by the terrorist attack. Using well-known and also relatively novel preventive population-based methodologies for minimizing the post-attack behavioral health-related morbidity resulted in the evolution of simplified principles ("Pieces of PIES") and methods (Therapy by Walking around and Care Management), which are briefly elaborated in this article.

Aircraft↗

PubMed2002

Psychiatry in the Korean War: perils, PIES, and prisoners of war.

In the initial months of the Korean War, very high numbers of psychological casualties occurred among American troops, 250 per 1,000 per annum. Initially, these men were evacuated to Japan or the United States, and very few of them were returned to duty. Then the principles of early and far-forward treatment, learned in the previous world wars, were reinstituted. Up to 80% of neuropsychiatric casualties were returned to duty. During and after the war, the prisoners of war were believed to have been "brainwashed," have "give-it-upitis," and exhibit apathy and depression. Mistakenly believed to be signs of moral decay, the psychiatric symptoms during and after release were probably a result of extended inhumane treatment and vitamin deficiencies.

History, 20th Century↗

PubMed2002

Psychological autopsies: the current Department of Defense effort to standardize training and quality assurance.

Psychological autopsies have been gathered by the US military for a long time, both for lessons learned after a known suicide and to investigate an equivocal death. The term "psychological autopsies" is now being restricted to define an investigation by mental health to help determine, in an equivocal death, if the manner of death is a homicide, suicide, an accident, or from natural causes. The Department of Defense has developed policy, and is now implementing training and peer review. A sample model curriculum, report format and quality assurance standards are included.

Autopsy↗